Minerva anestesiologica
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Minerva anestesiologica · Dec 2010
ReviewOROS® hydromorphone in chronic pain management: when drug delivery technology matches clinical needs.
The osmotic-controlled release oral delivery system (OROS®) is an innovative drug delivery technology that uses osmotic pressure as the driving force to deliver pharmacotherapies in many therapeutic areas. In chronic pain management requiring long-term therapy, pharmaceutical technologies that ensure the controlled release of analgesic medications are imperative. In addition, once-daily formulations ensure better patient compliance to prescribed therapies. ⋯ These studies support the clinical utility of the 5:1 ratio used for the conversion of oral morphine to oral OROS® hydromorphone. Furthermore, once-daily OROS® hydromorphone has been shown to be effective in patients with chronic cancer and non-cancer pain, and it provides similar pain relief to SR morphine and ER oxycodone. In chronic pain management, OROS® products can result in more stable drug concentrations, reduced dosing frequency and an improved safety profile.
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Minerva anestesiologica · Dec 2010
Randomized Controlled TrialA comparison of spinal anesthesia with low-dose hyperbaric levobupivacaine and hyperbaric bupivacaine for transurethral surgery: a randomized controlled trial.
The aim of this study was to compare spinal anesthesia effects of low-dose hyperbaric levobupivacaine and low-dose hyperbaric bupivacaine for transurethral procedures. ⋯ Although both techniques provide adequate spinal block and have few similar side effects for transurethral surgery, the use of low-dose hyperbaric levobupivacaine plus fentanyl may be preferable to low-dose hyperbaric bupivacaine plus fentanyl because of the reduced motor block, shorter duration of motor block, longer duration of sensory block and longer time to the first requirement for analgesia.
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Minerva anestesiologica · Dec 2010
Case ReportsAcute subdural intracranial hematoma after combined spinal-epidural analgesia in labor.
Intracranial subdural hematoma is a rare, but well-described complication of epidural and spinal anesthesia, as documented by more than a decade of publications. Non-postural headache and vomiting are warning signs. A headache lasting more than 5 days should arouse suspicion of intracranial hemorrhage, whether or not it is associated with the appearance of neurological signs or the deterioration of neurological status. ⋯ We report the case of a patient who suffered from severe neurological deterioration and manifested signs of brain herniation due to the development of an acute intracranial subdural hematoma after CSE analgesia for labor. An emergency craniotomy was performed to remove the subdural hematoma and the patient recovered well. Close observation of patients undergoing CSE analgesia or anesthesia complaining of prolonged non-postural headaches, with or without neurological symptoms, is recommended.